Permit CITY OF TIGARD MASTER PERMIT
I COMMUNITY DEVELOPMENT Permit#: MST2020 00245
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/01/2020
T t C3, ;1+d� Parcel: 1S134CA00535
Jurisdiction: Tigard
Site address: 11040 SW 119TH AVE
Subdivision: PANORAMA NO.2 Lot: 26
Project: Platt
Project Description: New 420 sf detached garage.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 11 Bathrooms: 0 Second: 0 sf Garage: 420 sf Front: 20 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5
Detectors: No
Total: 420 sf Value: $20,466.60 Rear: 5
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Tema Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add"500 sf: 0 201400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW ACS VB R-3 420
Owner: Contractor:
PLATT,SCOTT D&JODI L OWNER Required Items and Reports(Conditions)
11040 SW 119TH AVE 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97223
PHONE: PHONE:
FAX:
Total Fees: $721.38
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throu AR 9 n-0090. You may obtain a copy of the rules or direct questions to OUNC by calling503.232.1987 or 1.800.332.2344. /J
7j.Jn/Issued By. "Z4iX(, -� Permittee Signature: v/'V /, /�r 1. �4/ / /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential RECEIVEDiiiminciiiiiiiiiim
City of Tigard Received {Q�t
• 13125 SW Hall Blvd.,Tigard,OR 97223 J U L 3 0 2020 p1Dat anRe Review w/K1,�`� `v permit N ' eZ0 pQ Zy 5"
': ■ ' Phone: 503.718.2439 Fax: 503.598.1960 DateBy ��/,�N/�� ate permit:
i.i tl 1{in Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: 4 ((( Jade: HSee Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate a value(rounded to the nearest dollar)of all
yrAddition/alteration/replacement 0 Other:
o equipment,materials,n labor, anon.overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling 0 Commerciallindustrial Valuation: $ O
Accessory building 0 Multi-family Number of bedrooms:
ElMaster builder ElOther: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I I 0 l-}C) S t.J k i ck tI. C.il tL New dwelling area: square feet
City/State/ZIP: T i gorc3. 0 R- Q 71-2_3 Garage/carport area: L4`LC) square feet
Suite/bldg./apt.no.: cJ Project name: --p JLeA G-0_„,,,,,5e, Covered porch area: square feet
Cross street/directions to job site: ' I at-i-.tik (7)c K'Z.ow-t l- St: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: r70.4/1 0y0.441_p._ N o• 'Z Lot no.: . -6 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: I S 134C A 00 5 3 S equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
E c3.-k S f'V.-,-c-1 - 0- 1 S X 2_ Cl-.kz.,.�(--.e.-a
Valuation: $
S 1 nq l C.e-� o`'�'c) Existing building area: square feet
J c New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: S Co T T" PI--A r'r Type of construction:
Address: k '(34.p S1iJ k \Ck rt" 0.....04.r Occupancy uP Y groups:
City/State/ZIP: Tt o....-d C)( 9'7 ZZ3 Existing:
Phone:(St) ) 724 01'7 3 Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: --- (Please refer to fee.schedule) .
Structural plan review fee(or deposit): c2f y� / e7
Contact name: i�
--- FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax: :( )
E-mail: •
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
/� roof-top mounted PhotoVoltaic Solar Panel System.
/Business name: t J /v Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: (� Total fee due upon application: $.201.60
Authorized signature: SC`��) 1 —- This permit application expires if a permit is not obtained
r�,r—�" within 180 days after it has been accepted as complete.
*Print name: Se methodology set by Tri-County Building Industry
coC c�-1-r 1._A T Date: Pp/ I Z pZ� Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Property Owner Statement RECEIVED
Regarding Construction Responsibilities
AUG 27 20211
CITY OF TpliGvAis.RioDNI
Oregon Law requires residential construction permit applicants who are not licensed with!h IG
p
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building,electrical,mechanical,and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit
Please check the appropriate box:
1 1 I own, reside in or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
Or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
e)V
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board, If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the COB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
C-C)Tr. P LA ( i
Print Name of Permit Applicant
S—C
Signature of Permit Applicant Date
Permit* r-l&-r 2 0'2 r - 002-'1-5 -----:
Address: / ) 0 q 0 SO / 1 ui
1.'-ff.Tia,':=-:a:-:_•t.1-'..\
i*461,47.wfwi ::'4.14
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',
Issued by: ,.!r(14 _ Date:
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
IN ■
T I G A R D Building Permit Review — Residential
Building Permit #: PI 5 7 Zp 20 -G0 Z y_5
Site Address: 11040 SW 119th Ave
Project Name: Platt Garage Lot #:
Planning Review
Proposal: New 420-square-foot detached garage
❑r Verify address/suite #active in Accela. ❑o In River T rrae • ElNo ❑ Yes, River Terrace Review Addendum
Site Plan Elements: r sion Control
I: copies of site plan on 8-1/2"x 11"or 11 x 17"paper ° ained trees with drip line and tree protection measures
ID rawn to scale(standard architect or engineer scale) rint of new structure(including decks)and FFE
orth arrow ty locations&easements(required for new and additions)
01.ite address,project or subdivision name and lot number 'i walk/driveway approach
II pplicant information(name and phone number) ation of wells/septic systems
11(00 dimensions and building setback dimensions eet tree size,type and location
Duare footage of buildings to be demolished ° names
d . ting structures on site rner elevations (2'contours if more than 4'differential--
113'‘.t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es o
impervious area (applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es ° o
0 Clean Water Services —Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑r Yes,applicant was notified ❑ No Received: ❑Yes ❑a No
II Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: 0 Yes,applicant was notified ❑✓ No Received: ❑ Yes ❑ No
II SDC Exemption for ADU applied for: ❑ Yes ❑. No Received: El Yes ❑ No
II Public Facilities Improvement (PFI) Permit:
Required: ❑Yes,applicant was notified ❑✓ No Applied For: ❑ Yes ❑ No, stop intake
II Land Use Case #: ❑. Zoning: R-4.5
I Required Setbacks: Front: 20 Rear: 5 Side: 5 Street Side: 5 Garage: 20
ElBuilding Height: Max. Height: 15 Actual Height: 11
I : .dscape Area: % ❑ Lot Coverage Max:
Entrance Set back no more than 8'from street-facing wall 0 ' .nel to street or offset 45 degrees or less
Windows - r. r 12%of area of all street-facing facade W.
Garage _ Gara door' •-hind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
Door extends no ,•.re than 5'fro -•.I and there is a covered porch extending beyond garage.
II
Door extends no more t .• , rom wall and there is a 12 sq ft.window above garage on 2"d floor.
❑ Gara_•e door width is I 'or less 150%or less of facade 60%or less and includes 7 of following:
Covered po - I Recessed entrance II Wall offset ❑ 1'Roof cave Roof offset
Fir : rgles LapSiding ❑ Roof r Gable,hi or gambrel roof Dormer
0
Accent siding I indow trim Window r- UWindow projection El Balcony
ElVisual Clearance kr. rban Forest Plan
ElSe.sitive Lands: I Yes LJ No Type:
1` onditions met prior to issuance of building permit
Notes: _�
El Approved By Planning: Date: 8/5/20
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved El Not Approved
I\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: 7/3 0/20
Site Plans: # 3
Building Plans: #
Building Permit#: Enter buildingermit# above. n
Workflow Routing: Planning Engineering L7 rrrmit Coordinator `aBuilding
Workflow Sign-off: "Sign-off for Planning(include notes from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
iginal plan review routing form.
bil Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: ,9�
By Permit Technician: - l�\ Date: �/i y/6
Engineering Review _ J
Er Slope at building pad: ?i�
a-Conditions "Met"prior to issuance of building permit y f� '
LS>✓asements (encroachments) per engineering conditions of approval and plat 4/L—
Water Quality/Quantity Facility: Er
Assess Water Quality Fee in-lieu: ❑ Yes �E1yNo
Assess Water Quantity Fee in-lieu: ❑ Yes Er No
LIDA Facility on lot: ❑ Yes L'J No
Et-Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
[Approved by Engineering: %p{,...71" Ad_..4Date: ei7/Zo&
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
GS-Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
1 Revision Notice 2: Date Sent to Applicant: �j
SDC Exemption: ❑ Received (/� Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes I N/A
LIDA ❑ Yes N/A
KOK to Issue Permit
Approved by Permit Coordinator: Wr3
Oy V Date: 5 l(8 12-0
1:\B uil ding\Forms\BI dgPermitRvw_RFS_122419.docx